Biblioteca Virtual en Salud

Objective To analyze the clinical characteristics of Brucellar spondylitis and evaluate its surgical treatment effect.Methods From 2002 to 2015,the clinical data of diagnosed patients with Brucellar spondylitis aged ≥65 years old were collected retrospectively in the First Affiliated Hospital of Hebei North University,patients' clinical manifestations and characteristics,laboratory diagnosis,imaging changes and surgical treatment effects were analyzed.Pain and imaging scores and clinical efficacy were evaluated according to follow-up data within 12 months after surgery.Results A total of 38 cases of senile patients with Brucellar spondylitis were studied.The main clinical symptoms during the visit were persistent severe lumbar back pain,local tenderness,obvious percussion pain,muscle spasm,and constrained movements of spine.Rose bengal plate test (RBPT) was positive in 11 cases,serum tube agglutination test (SAT) titer was higher than 1100 in 28 cases.During the operation,28 cases of patients with inflammatory granuloma or abscess were cultured positive for Brucella.Before surgery,manifestations of X-rayof which 29 cases showed intervertebral space narrowing,the density increased,and the margins of the verbebral bodies destructed;of which 9 cases showed vertebral body bone sclerosing hyperplasia in the shape of a bird's beak,forming a bone bridge with the adjacent vertebral body margin.Manifestations of CTof which 29 cases showed different sizes and multiple lesions of the vertebral body margin,and hyperplasia and sclerosis around the lesion,and destruction of the lesion in the new bone tissue to form "lacy vertebra";in 9 cases,the destruction of intervertebral discs showed isodensity shadow,and the hyperplasia and sclerosis of articular surface resulted in the formation of "labial" osteophytes;of which 10 cases showed vertebral body destroyed the plane in which the bilateral psoas were widened and abscess formed.Manifestations of MRIof which 38 cases showed that the vertebral bodies,intervertebral discs,accompaniment and the intra of vertebral canal were uneven high signal and dural sac or cauda equina compression.The pain scores [(2.1 ± 0.2),(0.7 ± 0.4),(0.2 ± 0.1),(0.0 ± 0.0),(0.0 ± 0.0) scores] at 2 weeks and 1,3,6,12 months after surgery were significantly lower than that before surgery [(9.2 ± 0.3) scores,P ＜ 0.05].The blind imaging evaluation scores [(4.68 ± 0.04),(4.92 ± 0.08),(5.00 ±0.00) scores] at 3,6 and 12 months after surgery were significantly higher than that before surgery [(0.37 ± 0.03) scores,P ＜ 0.05].The cure rates of clinical efficacy [92.11％ (35/38),100.00％ (38/38)] at 6 and 12 months after surgery were significantly higher than that of 3 months after surgery [78.95％ (30/38),P ＜ 0.05)].Conclusions Senile Brucellar spondylitis has the typical imaging features,laboratory examination is helpful to early diagnosis.Surgery is much better to relieve the pain and stable spine function and accelerate rehabilitation.